From the Research
The major advantage of second-generation antipsychotics (SGAs) over first-generation antipsychotics (FGAs) is their superior effectiveness in relapse-free survival, psychiatric hospitalization rate, and treating negative symptoms, as well as higher persistence and adherence to therapy, as evidenced by a recent review of real-world studies 1.
Key Points
- SGAs have been shown to demonstrate superior effectiveness over FGAs in various clinical scenarios, including relapse-free survival and psychiatric hospitalization rate 1.
- SGAs are also more effective in treating negative symptoms, which are a significant component of schizophrenia 1.
- Persistence and adherence to therapy are higher in SGAs than FGAs, which can lead to better overall treatment outcomes 1.
- While SGAs offer several advantages, they also come with their own side effect profiles, particularly metabolic issues like weight gain, diabetes risk, and dyslipidemia 2.
Clinical Implications
- Clinicians should consider individual patient factors and monitor for both movement disorders and metabolic parameters when prescribing antipsychotics, regardless of which generation is selected.
- The choice of antipsychotic should be based on a careful evaluation of the patient's specific needs and medical history.
- Clozapine, a unique SGA, remains the gold standard for treatment-resistant schizophrenia despite requiring blood monitoring due to agranulocytosis risk 1.
Evidence Summary
- A recent review of real-world studies found that SGAs demonstrated superior effectiveness over FGAs in relapse-free survival, psychiatric hospitalization rate, and treating negative symptoms 1.
- Another study found that SGAs were associated with a lower risk of extrapyramidal symptoms and tardive dyskinesia compared to FGAs 3.
- A prospective naturalistic study found that olanzapine and risperidone were significantly superior to haloperidol in reducing hostile and aggressive behavior in outpatients with schizophrenia 4.